Provider Demographics
NPI:1043619711
Name:BROWN, KEVIN DARROW (LICSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DARROW
Last Name:BROWN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 BRIDGEPORT WAY W STE C1
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4325
Mailing Address - Country:US
Mailing Address - Phone:443-842-5661
Mailing Address - Fax:844-364-6544
Practice Address - Street 1:4113 BRIDGEPORT WAY W STE C1
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4325
Practice Address - Country:US
Practice Address - Phone:443-842-5661
Practice Address - Fax:844-364-6544
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical